Screen Failure Log: Adverse Events [AE_1] NCT01117584

General Information
Description

General Information

Was any adverse event reported or observed?
Description

Any Adverse Event

Type de données

boolean

Adverse Event
Description

Adverse Event

Type de données

text

Onset Date
Description

Onset Date

Type de données

date

End Date
Description

End Date

Type de données

date

Outcome
Description

Outcome

Type de données

text

Course of Event
Description

Course of Event

Type de données

text

Severity
Description

Severity

Type de données

text

Serious AE?
Description

If Seriousness is "yes", tick all that apply.

Type de données

boolean

Serious AE Number
Description

Serious AE Number

Type de données

integer

Death
Description

Death

Type de données

boolean

Requires or prolongs hospitalization
Description

Requires or prolongs hospitalization

Type de données

boolean

Congenital anomaly
Description

Congenital anomaly

Type de données

boolean

Life-threatening
Description

Life-threatening

Type de données

boolean

Persistent or significant disability/incapacity
Description

Disability

Type de données

boolean

Other medical importance
Description

Medical Importance

Type de données

boolean

Action Taken for Study Drug
Description

Action Taken for Study Drug

Type de données

text

Was there any treatment required?
Description

If Yes, please select all that apply.

Type de données

boolean

Medication Therapy
Description

Medication Therapy

Type de données

boolean

Non-Medication Therapy
Description

Non-Medication Therapy

Type de données

boolean

Relationship to Study Drug
Description

Relationship to Study Drug

Type de données

text

Similar models

Screen Failure Log: Adverse Events [AE_1] NCT01117584

Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
General Information
Any Adverse Event
Item
Was any adverse event reported or observed?
boolean
Adverse Event
Item
Adverse Event
text
Onset Date
Item
Onset Date
date
End Date
Item
End Date
date
Item
Outcome
text
Code List
Outcome
CL Item
Recovered/Resolved (1)
CL Item
Recovering/Resolving (2)
CL Item
Not Recovered/Not Resolved  (3)
CL Item
Recovered/Resolved with Sequelae (4)
CL Item
Fatal (5)
CL Item
Unknown (6)
Item
Course of Event
text
Code List
Course of Event
CL Item
Single Episode (1)
CL Item
Intermittent (2)
CL Item
Continous (3)
Item
Severity
text
Code List
Severity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Serious AE
Item
Serious AE?
boolean
Serious AE Number
Item
Serious AE Number
integer
Death
Item
Death
boolean
Requires or prolongs hospitalization
Item
Requires or prolongs hospitalization
boolean
Congenital anomaly
Item
Congenital anomaly
boolean
Life-threatening
Item
Life-threatening
boolean
Disability
Item
Persistent or significant disability/incapacity
boolean
Medical Importance
Item
Other medical importance
boolean
Item
Action Taken for Study Drug
text
Code List
Action Taken for Study Drug
CL Item
Dose Not Changed (1)
CL Item
Drug Interrupted (2)
CL Item
Drug Withdrawn  (3)
CL Item
Not Applicable (4)
CL Item
Unknown (5)
Treatment
Item
Was there any treatment required?
boolean
Medication Therapy
Item
Medication Therapy
boolean
Non-Medication Therapy
Item
Non-Medication Therapy
boolean
Item
Relationship to Study Drug
text
Code List
Relationship to Study Drug
CL Item
Not Related (1)
CL Item
Possible (2)
CL Item
Probable (3)